机器人辅助根治性膀胱切除术患者采取术中体温管理后围术期低体温发生情况及其影响因素  

Incidence of perioperative hypothermia and its influencing factors in patients undergoing robot-assisted radical cystectomy after intraoperative temperature management

作　　者：杨芳[1] 蔺洁璐 王黎萍 王婷婷 YANG Fang;LIN Jielu;WANG Liping;WANG Tingting(Operating Room,Xi’an No.3 Hospital/the Affiliated Hospital of Northwest University,Xi’an 710021,China;Department of Critical Care Medicine,Yan’an Hospital of Traditional Chinese Medicine,Yan’an 716000,China)

机构地区：[1]西北大学附属医院·西安市第三医院手术室,陕西西安710021 [2]延安市中医医院重症医学科,陕西延安716000

出　　处：《机器人外科学杂志(中英文)》2025年第1期128-133,共6页Chinese Journal of Robotic Surgery

基　　金：陕西省重点研发计划项目(2017ZDXM-SF-045)。

摘　　要：目的:分析机器人辅助根治性膀胱切除术(RARC)患者采取术中体温管理后围术期低体温发生情况及其影响因素。方法:选取2018年3月—2020年8月西安市第三医院收治的39例行常规术中护理的RARC患者,将其纳入对照组,另选取2020年9月—2023年3月西安市第三医院收治的39例行术中保温护理的RARC患者,将其纳入观察组。比较两组患者不同时点体温水平。结果:两组患者术中1 h、3 h、5 h体温低于术前,术中5 h体温高于术中3 h,观察组术中1 h、3 h、5 h体温均高于对照组(P<0.05);观察组低体温发生率低于对照组(P<0.05)。BMI<24 kg/m^(2)、护理方式为常规术中护理、腹腔冲洗液量>500 mL、术中补液量>1500 mL及手术时间、气腹时间和麻醉时间长的患者低体温发生率高于BMI≥24 kg/m^(2)、护理方式为术中保温护理、腹腔冲洗液量≤500 mL、术中补液量≤1500 mL及手术、气腹、麻醉时间短的患者(P<0.05)。二元Logistic回归分析结果显示,手术时间和气腹时间长、腹腔冲洗液量>500 mL、术中补液量>1500 mL是RARC患者围术期低体温发生的危险因素(OR>1,P<0.05),采取术中体温管理是RARC患者围术期低体温发生的保护因素(OR<1,P<0.05)。结论:术中体温管理能够有效稳定RARC患者术中体温,降低低体温发生率,且手术时间、气腹时间、腹腔冲洗液量、术中补液量及护理方式是RARC患者围术期低体温发生的影响因素。Objective:To analyze the incidence of perioperative hypothermia and its influencing factors in patients undergoing robot-assisted radical cystectomy(RARC)after intraoperative temperature management.Methods:78 RARC patients in the Third Hospital of Xi’an from March 2018 to March 2023 were selected and divided into the control group(March 2018 to August 2020,routine intraoperative nursing,n=39)and the observation group(September 2020 to March 2023,intraoperative heat preservation nursing,n=39).Body temperatures of patients at different time points was compared between the two groups.Results:Body temperatures at intraoperative 1 h,3 h and 5 h were lower than that before surgery,and the temperatures at intraoperative 5 h were higher than that at 3 h during surgery.Compared to the control group,the observation group demonstrated a lower incidence of hypothermia(P<0.05)and a higher temperature at 1 h,3 h,and 5 h during surgery(P<0.05).The incidence of hypothermia was higher in patients with body mass index<24 kg/m^(2),routine intraoperative nursing,abdominal lavage volume>500 mL,intraoperative rehydration volume>1500 mL,longer operative time,pneumoperitoneum time and anesthesia time than patients with body mass index≥24 kg/m^(2),intraoperative warming nursing,abdominal lavage volume≤500 mL,intraoperative rehydration volume≤1500 mL,shorter operative time,pneumoperitoneum time and anesthesia time(P<0.05).Logistic regression results showed that long operative and pneumoperitoneum time,abdominal lavage volume>500 mL,and intraoperative rehydration volume>1500 mL were risk factors for perioperative hypothermia(OR>1,P<0.05),and intraoperative body temperature management was a protective factor in RARC patients(OR<1,P<0.05).Conclusion:Intraoperative temperature management can effectively stabilize the intraoperative body temperature and reduce the incidence of hypothermia.The operative time,pneumoperitoneum time,peritoneal lavage volume,intraoperative rehydration volume,and nursing methods are the influencing factors o

关 键 词：膀胱癌 机器人辅助根治性膀胱切除术 术中体温管理 低体温 影响因素 

分 类 号：R472.3[医药卫生—护理学] R669.5[医药卫生—临床医学]